Current Dialysis Techniques Research Articles

#1573 Effects of haemodialysis coupled with hemadsorption on uremic toxins removal, oxidative stress and cellular death.

Abstract Background and Aims The retention of middle-molecules and Protein Bound Uraemic Toxins (PBUT) in dialysis patients are directly linked to specific clinical complications such as anaemia, inflammation and cardiovascular disease leading to increased mortality. These toxins, not adequately cleared by current dialysis techniques, could be removed by adsorption as demonstrated in numerous studies on dialysis patients. Furthermore, in dialysis patients there's an increased inflammation and oxidative stress only partially attenuated by biocompatibility of newly developed membraned. This pathologic inflammatory response lead to tissue damage and cellular death. A particular form of programmed cellular death involving red blood cells is called Eryptosis and is detectable as changes in the morphology and in the shape of human erythrocytes. The aim of this study was to assess the safety of dialysis coupled with hemadsorption (HA+HD) in terms of biocompatibility and efficacy in terms of removal of middle-molecules and PBUTs. Method This was a preliminary analysis of a multicentre observational study that evaluated 4 dialysis session focusing on 7 chronic dialysis patients of our dialysis centre. Patients were treated with HA+HD with HA130 cartridge (Jafron) only in the early-week dialysis session and then returned to their usual prescription. Blood samples were taken before and after dialysis session in order to measure Eryptosis as a marker of biocompatibility and few uremic toxins to assess the efficacy of the treatment by using Removal Ratio. Eryptototic RBCs were identified by FS (cell volume dimension) and FITC_AnnexinV-binding (Beckman Coulter, Brea, CA, USA) using Navios Flow Cytometer (Beckman Coulter, Brea, CA, USA). A minimum 100.000 events were collected on each sample. Statistical analysis was performed using the SPSS Software package. A p-value of <0.05 was considered statistically significant. Results This study was carried out on 7 patients (4 women) with a mean age of 65.7 ± 11.5 years and a median dialysis vintage of 33 months (IQR 28-51). All patients had AVF with Qb of 330 ml/min. Dialysis length was 210 minutes. We didn't find any differences between Eryptosis values measured before and after dialysis (Table 1), and between different timepoints. We found significant reduction of PTH (pre: 391.5 ng/L, IQR 206.5-602.8 vs post: 162.0 ng/L, IQR 95.0-363.3; p=0.005) and β2-microglobulin (pre: 23.10 mg/L, IQR 22.1-24.1 vs post: 6.72 mg/L, IQR 6.2-8.3; p>0.005) throughout the dialysis session coupled with hemadsorption (Fig. 1). Conclusion In this preliminary analysis, we found that the association of Dialysis with Hemadsorption allows a great removal of middle molecular-weight uremic toxins without compromise biocompatibility and thus represent a better treatment option in patients with high retention of these toxins.

Hemoadsorption Combined with Hemodialysis and the “Inflammation Mitigation Hypothesis”

ABSTRACT Clinical outcomes are still unsatisfactory in patients undergoing chronic maintenance dialysis. Signs and symptoms of uremic intoxication are often present even in presence of an adequate dialysis delivery. These along with cardiovascular and skeletal complications, have been correlated to the accumulation of inflammatory chemical mediators, beta-2 microglobulin (β2M), parathyroid hormone (PTH) and other middle to large molecular weight toxins that are insufficiently cleared by current dialysis techniques. Such condition determines a vicious loop where a subclinical status of inflammation causes a disruption of the immunological response affecting outcomes by accelerated atherosclerosis, anemia, and frequent infections. The overall picture can be described as a systemic inflammatory syndrome with simultaneous activation of the innate and the adaptive immunity. In such condition, new options and techniques are required to achieve a more effective blood purification and to correct the altered immuno-homeostasis. New efficient and biocompatible sorbents are today available (HA 130 Cartridge, Jafron Medical, Zhuhai, China) and they can be advantageously coupled in series with the hemodialyzer to perform hemoadsorption combined with hemodialysis (HA-HD). This technique has been already studied in at least two randomized trials demonstrating an effective improvement of clinical and biochemical outcomes. We have calculated the kinetics of β2M in a single session, in a series of three consecutive sessions of a week and in a period of three months using different frequencies of application (first month: Three sessions per week; second month: Two sessions per week; third month: One session per week). In the single session the reduction ratio was superior to other techniques such as hemodialysis (HD), high-flux hemodialysis (HFD) or hemodiafiltration (HDF). In the thrice weekly regime, the time average concentration (TAC) of β2M resulted inferior to HD and HDF. In the long period, a lower concentration of β2M was maintained even with a once-a-week regime. Considering the parallel reduction of inflammatory parameters, we could hypothesize that the enhanced removal of uremic toxins and chemical mediators led to a mitigation of the systemic inflammation with a progressive reduction in the generation of β2M. This “inflammation mitigation hypothesis (IMH)” supports the prescription of HA-HD once a week, possibly after a month of thrice weekly regime.

Biochemical markers of iron status and iron accumulation in peritoneal dialysis patients treated with ferric citrate.

Hyperphosphataemia is a common complication of kidney disease. Current dialysis techniques do not provide enough phosphorus clearance, hence the need to use phosphorus binders. Treatment options include calcium carbonate, calcium acetate, lanthanum carbonate, sevelamer hydrochloride and iron-based binders. Patients receiving peritoneal dialysis (PD) with sustained elevated ferritin levels exceeding 800 ng/mL are at a higher risk of death. We identify PD patients treated with iron-based binders and compare ferritin and risk of iron accumulation to patients treated with non-iron-based binders. All records of patients receiving PD at Emory dialysis centres until 30 October 2021 were reviewed for phosphorus binders. Basic demographics and laboratory data were time-referenced to the days on treatment with a particular binder. Patients were followed until discontinuation of the phosphorus binder, death, transplant, transfer to another dialysis provider or censoring at 36 months after medication was started. Compared to calcium acetate and sevelamer, ferric citrate utilisation in PD patients resulted in a sustained increase in ferritin. The proportion of patients with a ferritin equal to or greater than 800 ng/dL and transferrin saturation greater than 40% increased over time in patients treated with ferric citrate and was higher during the second and third year of follow-up compared to baseline values and to patients treated with calcium acetate or sevelamer. Two patients (7%) treated with ferric citrate developed clinically significant haemosiderosis. Use of ferric citrated in PD resulted in significant iron accumulation as judged by ferritin levels.

Protein-Bound Uremic Toxins and Inflammation Process in Hemodialysis Patients: Is There a Role for Adsorption Hemodiafiltration?

Introduction: Despite major advances in the field of dialysis, there are still some unmet needs such as reducing inflammation through adequate depuration. It is well known that the wide spectrum of pro-inflammatory and pro-atherosclerotic uremic toxins are inefficiently removed by current dialysis techniques. Adsorption seems to be an extra tool to remove toxins, but its effect and optimization have not been widely studied. The aim of this report was to present preliminary results regarding the possibility of performing hemodiafiltration with a highly adsorptive polymethylmethacrylate membrane. Methods: The study was first conducted in 10 patients in which the safety and feasibility of hemodiafiltration with PMMA BG-U 2.1 membrane were tested through measurement of hemolysis indices, transmembrane pressures, and dialysis adequacy. Twenty patients were prospectively observed for 18-month period in which they consecutively underwent standard hemodialysis, standard post-dilution hemodiafiltration, and polymethylmethacrylate-based post-dilution hemodiafiltration. Protein-bound uremic toxins concentrations and inflammatory markers were measured throughout the observed period. Results: HDF-PMMA was inferior to HDF in convective volume, but KT/V was similar, and no differences were noted in operating pressures during the two treatments. During HDF-PMMA period of treatment, we observed a significant reduction of CPR levels, and HDF-PMMA was superior to all other treatments in hepcidin removal even if this did not significantly affect hemoglobin levels. HDF-PMMA could significantly reduce indoxyl sulfate (indoxyl) concentration over a period of 6 months but not for p-cresyl sulfate (p-cresyl). Conclusion: PMMA BG-U 2.1 membrane can be safely and efficiently used in hemodiafiltration. Moreover, as these preliminary results show, adding adsorption properties to convection and diffusion enabled an increased removal of indoxyl uremic toxin associated to a reduction in inflammation markers as CRP and hepcidin without any negative impact on albumin levels.

The Dual Roles of Protein-Bound Solutes as Toxins and Signaling Molecules in Uremia.

In patients with severe kidney disease, renal clearance is compromised, resulting in the accumulation of a plethora of endogenous waste molecules that cannot be removed by current dialysis techniques, the most often applied treatment. These uremic retention solutes, also named uremic toxins, are a heterogeneous group of organic compounds of which many are too large to be filtered and/or are protein-bound. Their renal excretion depends largely on renal tubular secretion, by which the binding is shifted towards the free fraction that can be eliminated. To facilitate this process, kidney proximal tubule cells are equipped with a range of transport proteins that cooperate in cellular uptake and urinary excretion. In recent years, innovations in dialysis techniques to advance uremic toxin removal, as well as treatments with drugs and/or dietary supplements that limit uremic toxin production, have provided some clinical improvements or are still in progress. This review gives an overview of these developments. Furthermore, the role protein-bound uremic toxins play in inter-organ communication, in particular between the gut (the side where toxins are produced) and the kidney (the side of their removal), is discussed.

Effects of a medium cut-off (Theranova®) dialyser on haemodialysis patients: a prospective, cross-over study.

BackgroundDespite significant advances in haemodialysis (HD) in recent decades, current dialysis techniques are limited by inadequate removal of uraemic solutes such as middle molecules and protein-bound uraemic toxins. Novel medium cut-off (MCO) membrane or ‘expanded haemodialysis’ (HDx) provides diffusive removal of conventional and large middle molecular weight uraemic toxins, with marginal albumin leak.MethodsThis prospective, open-label, controlled, cross-over pilot study compared HDx (novel MCO membrane Theranova® 400) and conventional HD in 20 prevalent HD patients. Biochemical, dialysis adequacy and safety measures (adverse events, infections and hospitalization frequency) were recorded. Ten patients underwent conventional HD high-flux dialyser and 10 patients underwent HDx for 3 months, and the patients then switched and received the other treatment for a further 3 months.ResultsTreatment with HDx was associated with a significant reduction in serum albumin concentration [median (interquartile range) reduction −0.45 g/dL (−0.575 to −0.05); P = 0.025]. However, median albumin levels were ≥3.5 g/dL and no patients had clinical symptoms of hypoalbuminaemia or needed intravenous albumin administration. The number of infections was lower in patients treated with HDx (n = 7/19) compared with patients treated with HD (n = 14/20; P = 0.03). Patients treated with HDx had reduced levels of interleukin (IL)-1β (from 0.06 ± 0.02 pg/mL versus 0.28 ± 0.18 pg/mL with HD) and IL-6 (6.45 ± 1.57 pg/mL versus 9.48 ± 2.15 pg/mL), while tumour necrosis factor-α levels remain unchanged.ConclusionsThis study demonstrates that the chronic use of the novel MCO dialyser Theranova® appears to be safe and well-tolerated, without serious side effects or hypoalbuminaemia, as well as fewer infections. These results need to be confirmed in larger randomized clinical trials.

WEAKID - Clinical validation of miniature wearable dialysis machine - H2020

The project aims to validate a miniature wearable dialysis machine in a clinical setting and to prepare the system for CE-marking. Wearable dialysis allows renal patients to dialyze conveniently and continuously at home or at work, independently from a fixed water supply, up to 24 hrs/day. Such a continuous treatment mimics healthy kidneys and is twice as effective as current dialysis techniques, hereby offering health benefits, quality of life (fitness, mobility) while reducing medical costs (less medication, dialysis at home lowers costs). The miniature wearable dialysis system is based on continuous flow peritoneal dialysis with a fluidic access to the abdomen. The peritoneal dialysate is continuously circulated and refreshed by means of a small and wearable sorption unit that removes toxins from the dialysate. The technology has been demonstrated in preclinial research. In order to demonstrate the clinical efficacy and safety of the system an early feasibility first-in-human trial (phase 0) and a pilot crossover trial (phase 1) will be performed in peritoneal dialysis (PD) patients. The phase 0 study will involve a selected group of 12 stable PD patients in a clinical setting for 5 consecutive days. Upon successful functionality and safety analysis of the phase 0 trial, the clinical validation is continued in a crossover study to test the hypotheses that the system (1) improves blood purification, (2) results in adequate ultrafiltration and (3) does not show important safety/biocompatibility problems. Hereto 30 stable PD patients will be randomised to receive either with the wearable system in the first month and conventional PD in the second month or vice versa. The clinical trials will be performed by three European medical centres specialised in dialysis treatment.

Expanded Hemodialysis: A New Therapy for a New Class of Membranes.

A wide spectrum of molecules is retained in end-stage kidney disease, normally defined as uremic toxins. These solutes have different molecular weights and radii. Current dialysis membranes and techniques only remove solutes in the range of 50-15,000 Da, with limited or no capability to remove solutes in the middle to high molecular weight range (up to 50,000 Da). Improved removal has been obtained with high cut-off (HCO) membranes, with albumin loss representing a limitation to their practical application. Hemodiafiltration (HDF) at high volumes (>23 L/session) has produced some results on middle molecules and clinical outcomes, although complex hardware and high blood flows are required. A new class of membrane has been recently developed with a cut off (MWCO) close to the molecular weight of albumin. While presenting negligible albumin loss, these membranes have a very high retention onset (MWRO), allowing high clearances of solutes in a wide spectrum of molecular weights. These membranes originally defined (medium cut off) are probably better classified as high retention onset. The introduction of such membranes in the clinical routine has allowed the development of a new concept therapy called "expanded hemodialysis" (HDx). The new therapy is based on a special hollow fiber and dialyzer design. Its simple set-up and application offer the possibility to use it even in patients with suboptimal vascular access or even with an indwelling catheter. The system does not require a particular hardware or unusual nursing skill. The quality of dialysis fluid is, however, mandatory to ensure a safe conduction of the dialysis session. This new therapy is likely to modify the outcome of end-stage kidney disease patients, thanks to the enhanced removal of molecules traditionally retained by current dialysis techniques.

Protein-Bound Uremic Toxins from Gut Microbiota and Inflammatory Markers in Chronic Kidney Disease.

Protein-bound uremic toxins from gut microbiota tend to accumulate in chronic kidney disease (CKD) patients and are poorly removed by current dialysis techniques. These toxins induce inflammation and are associated with cardiovascular disease (CVD). The aim of this study was to report the relationship between uremic toxins and inflammatory and cardiovascular markers in CKD patients. This was a cross sectional study. Twenty-one nondialysis patients were included (43% men, 63.0±7.8years, glomerular filtration rate: 34.4±12.5mL/min) as well as 29 hemodialysis (HD) patients [58% men, 52.7±10.3years, time on dialysis 54 (31-94.5months)]. Total levels of uremic toxins (IS, p-CS, and IAA) were assessed by high-performance liquid chromatography with fluorescence detection. C-reactive protein, Interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and calprotectin plasma levels were determined by immunometric assays. HD patients presented higher inflammatory markers and uremic toxins levels than nondialysis patients. IL-6 levels were positively correlated with IS (r=0.49; P=.03), p-CS (r=0.35; P=.04) and IAA (r=0.36; P=.03). A positive correlation was also observed between MCP-1 levels with IS (r=0.72; P=.001), p-CS (r=0.48; P=.001) and IAA (r=0.75; P=.0001). Linear regression showed that IS was an independent predictor for IL-6 and MCP-1 levels after adjustment. Plasma uremic toxins were associated with higher IL-6 and MCP-1 levels in CKD patients, potentially playing a role in the development of CVD.

Why choose high volume online post-dilution hemodiafiltration?

The mortality rate of patients on maintenance dialysis remains alarmingly high, at approximately 15-20 % per year. Increasing dialyzer urea clearance has not been shown to improve survival and hence interest has shifted towards convective therapies, such as hemodiafiltration (HDF) which can remove middle molecular weight uremic toxins, which have been suggested to increase mortality in patients with end-stage kidney disease. During the last few years, four large prospective randomized controlled trials (RCTs) have been conducted in different European countries to compare survival outcomes in prevalent patients receiving conventional hemodialysis with online post-dilution HDF (OL HDF). Furthermore, a pooled individual participant data analysis from four RCTs was performed and four large meta-analyses on convective therapies have been published in the last 2years. Taken together, these studies support the conclusion that high volume post-dilution OL HDF is associated with improved overall survival. This advantage results predominantly from a lower cardiovascular mortality, possibly due to better preservation of left ventricle mass and function. Improved intra-dialytic blood pressure stability may contribute to the beneficial effect of high volume post-dilution OL HDF on survival. The beneficial effect is not restricted to selected subgroups, such as age, comorbidity or dialysis vintage. There is no compelling evidence that high volume post-dilution OL HDF reduces mortality by improvements in traditional and non-traditional risk factors. There are still no studies or case reports published describing adverse clinical outcomes in more than 20years of HDF clinical experience. In conclusion, most of the available data support the choice of high volume post-dilution HDF over the current dialysis techniques. However, considering that we live in the era of evidence-based medicine, the evidence supporting the superiority of high volume post-dilution OL HDF in comparison to hemodialysis is still missing: in fact, a new RCT targeting different convection volumes would be needed to definitively examine the dose-response effect shown in previous studies.

The first year on haemodialysis: a critical transition.

The first year following the start of haemodialysis (HD) is associated with increased mortality, especially during the first 90–120 days after the start of dialysis. Whereas the start of dialysis has important effects on the internal environment of the patient, there are relatively few studies assessing changes in phenotype and underlying mechanisms during the transition period following pre-dialysis to dialysis care, although more insight into these parameters is of importance in unravelling the causes of this increased early mortality. In this review, changes in cardiovascular, nutritional and inflammatory parameters during the first year of HD, as well as changes in physical and functional performance are discussed. Treatment-related factors that might contribute to these changes include vascular access and pre-dialysis care, dialysate prescription and the insufficient correction of the internal environment by current dialysis techniques. Patient-related factors include the ongoing loss of residual renal function and the progression of comorbid disease. Identifying phenotypic changes and targeting risk patterns might improve outcome during the transition period. Given the scarcity of data on this subject, more research is needed.

Protein-Bound Uremic Toxins: New Culprits of Cardiovascular Events in Chronic Kidney Disease Patients

Chronic kidney disease (CKD) has been considered a major risk factor for cardiovascular diseases. Although great advances have recently been made in the pathophysiology and treatment of cardiovascular diseases, CKD remains a major global health problem. Moreover, the occurrence rates of cardiovascular events among CKD patients increase even in cases in which patients undergo hemodialysis, and the mechanisms underlying the so-called “cardiorenal syndrome” are not clearly understood. Recently, small-molecule uremic toxins have been associated with cardiovascular mortality in CKD and/or dialysis patients. These toxins range from small uncharged solutes to large protein-bound structures. In this review, we focused on protein-bound uremic toxins, such as indoxyl sulfate and p-cresyl sulfate, which are poorly removed by current dialysis techniques. Several studies have demonstrated that protein-bound uremic toxins, especially indoxyl sulfate, induce vascular inflammation, endothelial dysfunction, and vascular calcification, which may explain the relatively poor prognosis of CKD and dialysis patients. The aim of this review is to provide novel insights into the effects of indoxyl sulfate and p-cresyl sulfate on the pathogenesis of atherosclerosis.

Innovation in the Treatment of Uremia: Proceedings from the Cleveland Clinic Workshop: Renal Cell Therapy and Beyond

Although current dialysis techniques have transformed acute and chronic renal failure from uniformly fatal clinical disorders into treatable diseases, these therapies replace only the water and solute clearance function of the kidney and have reached a point where little further therapeutic improvement can be anticipated. In addition to their metabolic and endocrine functions, renal tubule cells presumably play an important role in the systemic inflammatory balance by participating in the complex and dynamic network of leukocyte action and pro- and anti-inflammatory cytokines. Loss of this function may result in a propensity to develop systemic inflammatory response syndrome (SIRS), multiorgan dysfunction, and a high risk of death in acute kidney injury (AKI), and may relate to chronic inflammatory state in end-stage renal disease (ESRD). A renal tubule cell assist device (RAD) containing animal or human renal tubule cells has been recently developed with the purpose of integrating the functions of tubule cells with the filtration function of current dialysis to offer a more complete renal replacement therapy. The viability and functionality of this device were confirmed in in vitro experiments and large animal studies, and recently the RAD's clinical therapeutic benefit was demonstrated with a series of FDA-approved human trials. Another novel synthetic membrane extracorporeal device that binds and inhibits circulating leukocytes has been developed with the purpose of reducing microvascular damage promoted primarily via activated circulating leukocytes in AKI and SIRS. This device, called a selective cytopheretic inhibitory device, mimics immunomodulation and duplicates RAD efficiency in preliminary studies. Both devices may become comprehensive treatments, replacing full renal function and correcting inflammatory imbalance in patients with acute and chronic renal disorders.

The use of stem cells in kidney disease

Acute and chronic kidney disease is a leading cause of morbidity and mortality worldwide with overall mortality rates between 50 and 80%. An acute shortage of compatible organs coupled with limited adaptability of current dialysis techniques has created a sense of urgency to investigate new alternatives, and the purpose of this review is to provide a concise overview of current stem cell-based strategies in renal repair following acute kidney injury. Bone marrow-derived mesenchymal stem cells hold therapeutic potential in repairing tubular injury, ameliorating renal function deficits, and prolonging survival in experimental models of acute kidney injury. These renoprotective effects are mediated mainly by paracrine mechanisms that act on surviving tubular cells by stimulating dedifferentiation, proliferation, migration, and eventually redifferentiation into mature epithelial cells as well as by stimulating expansion and differentiation of resident stem/progenitor cells. Mesenchymal stem cells are capable of immunosuppression as well as inducing protection against peritubular capillary changes following acute injury making them ideal for allogeneic cell therapy. Autologous transplantation of bone marrow-derived mesenchymal stem cells as well as adult renal stem/progenitor cells that can be easily harvested and expanded may be the solution to limited donor organ availability and chronic immunosuppressive therapy.

Elimination of an outbreak of gram-negative bacteremia in a hemodialysis unit

Background: The purpose of this study was to identify the cause of an unusual outbreak of gram-negative bacteremia in patients undergoing long-term hemodialysis. Methods: We performed direct observation and investigation of current dialysis techniques and facilities including microbiological sampling in a long-term hemodialysis unit in a tertiary care center. We also performed a retrospective review of medical charts and laboratory data of 10 patients undergoing long-term hemodialysis who experienced 11 episodes of gram-negative bacteremia between March and June 28, 1993. Results: All of these patients underwent dialysis by jugular venous access. Containers used to collect flush solution after priming of dialysis tubing remained unemptied for extended periods of time, and quantitative culture revealed more than 200 colony-forming units/ml gram-negative bacilli, including species isolated in blood cultures. Dialysis tubing and connector were left submerged in flush solution collection containers during priming, and the process of disinfecting tubing before patient connection had recently been discontinued. Control measures included emptying of flush containers after each use and daily decontamination. All dialysis tubing was to be disinfected before patient connection. Conclusion: Outbreak was due to contamination during dialysis setup. After institution of appropriate control measures, no new cases have occurred.

Impact of Current Dialysis Techniques on Copper Status and Acute Phase Response in Females

The impact of current dialysis techniques on indicators of copper status and acute phase response was investigated in this research study to determine whether differences occurred between females dialysed using maintenance hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD).Methodology: Female subjects with end stage renal disease for less than 5 years receiving either maintenance HD, or CAPD, and healthy female controls consented to participate. HD subjects (n = 11; 5 African-American and 6 Caucasian) ranged in age from 28–77 yr (48.0 ± 18.2 yr). HD subjects were dialyzed using cellulose ester (n=3), cellulose acetate (n=4), and polysulfone (n=4) dialyzers. CAPD subjects (n=l1; 11 Caucasian) ranged from 24–70 yr (53.5 ± 13.2 yr). Control subjects (n=11; 11 Caucasian) ranged in age from 24–64 yr (40.1 ± 12.5 yr). Plasma albumin, plasma creatinine, plasma glucose, and blood urea nitrogen were assayed in controls to confirm normal health status. Plasma was collected in trace element grade tubes to obtain fasting plasma copper (Cu), plasma ceruloplasmin activity (CpA), plasma ceruloplasmin concentration (CpC), ceruloplasmin activity to concentration (CpA:CpC), erythrocyte superoxide dismutase with extracted protein (RBCSOD), and plasma interleukin-6 (IL-6). Indicators of copper status and acute phase response were assayed as follows: Cu using atomic absorption spectrophotometry; CpA and RBCSOD using spectrophotometry, CpC using radial immunodifiusion; and IL-6 using an enzyme-linked immunoabsorbent asssay.Statistical Analyses: All data was expressed as mean ± S.D. using the Statistical Analysis Software Program. ANOVA were calculated and considered statistically significant at P< 05.Maior findings: Plasma Cu (1.0 ± .3ng/mL) was significantly (P< 01; ANOVA) depressed in HD only. CpA was significantly (P<01) depressed in both HD (78.27 ± 22.09U/L) and CAPD (94.55 ± 43.39U/L). CpC (687 ± 254mg/L) was significantly (P<05) depressed in HD only. CpA: CpC was significantly depressed (P<01) in both HD (0.17 ± 44U/mg) and CAPD (0.14 ± .53U/mg). RBCSOD (1952.1 ± 980.3U/mg) was significantly (P<01) elevated in HD only. Plasma interleukin-6, an indicator of acute phase response, was significantly (P<.05) elevated in both HD (3.2 ± 4.3pg/mL) and CAPD (3.0 ± 3.1pg/mL). Comparisons between dialysis treatment groups revealed significantly (P<05) depressed CpC and RBCSOD concentrations in females receiving HD compared to those receiving CAPD.Conclusions: This study suggests that despite technical improvements in maintenance dialysis techniques indicators of copper status and acute phase response are abnormal in females undergoing either HD or CAPD. These findings further suggest fewer copper anomalies occur in females prescribed CAPD compared to HD.